Radioguided Surgery for Head and Neck Cancer

Abstract

Radioguided surgery for head and neck cancer has emerged as an important field of interventional nuclear medicine. Currently, the two most important applications concern sentinel lymph node (SLN) biopsy for cutaneous melanoma and oral cavity squamous cell carcinoma (OCSCC). An emerging application is SLN biopsy in thyroid cancer. Similar to other anatomic regions, the dynamic concept Guided intraOperative Scintigraphic Tumor Targeting (GOSTT) is also of use for the head and neck, and besides the SLN procedure, the use of local or systemic administered radiotracers has led to gradually integrate interventional nuclear medicine to surgery of radiotagged lesions related to thyroid cancer and parathyroid adenomas. For all these procedures, the successive incorporation of SPECT/CT and PET/CT in the last years has optimized the generation of specific imaging roadmaps to guide head and neck surgery. On the other hand, new technological advances like portable gamma cameras, hybrid tracers integrating radioactivity and fluorescence in one signature with the addition of near-infrared cameras to gamma guidance in the operating room, and tracked image-guided navigation have further reinforced the role of GOSTT and interventional nuclear medicine. In combination with the topographical localization of SLNs following internationally recognized surgical and radiotherapeutic lymph node levels, recent consensus initiatives from nuclear medicine and oncologic organizations have been of considerable help to homogenize approaches and practice of radioguided surgery in the head and neck.KeywordsRadioguided head and neck surgerySentinel lymph nodeOral cavity cancerMelanomaPreoperative SPECT/CTPreoperative PET/CTLocal and systemic tracer administrationGuided intraOperative Scintigraphic Tumor TargetingGOSTTIntraoperative Portable Imaging TechnologiesHybrid intraoperative techniquesInterventional nuclear medicine